Men's Health

Treatment Options for Prostate Cancer Abound

A diagnosis of prostate cancer may prompt an understandable feeling of dread, but patients actually have a wide variety of treatment options at their disposal for tackling the disease, medical experts say.

Because there are so many choices available, a man's quality of life should be considered strongly when weighing the risks and benefits of the various therapies. In fact, a growing number of doctors say many prostate cancers are better off being left untreated.

"It's been said that more men die with prostate cancer than of prostate cancer," says Dr. Durado Brooks, director of prostate cancer for the American Cancer Society.

"For a significant number of these men, if they have other health problems that are likely to shorten their life span, in many instances they aren't likely to live long enough for the prostate cancer to cause them any problem,” he says.

The survival rate for prostate cancer is very high. Overall, 99 percent of men diagnosed with prostate cancer survive at least five years, according to the American Cancer Society.

Furthermore, 91 percent of all prostate cancers are found while they are still within the prostate or only in nearby areas. The five-year relative survival rate for those men is almost 100 percent.

Consider the Pluses and Minuses

"Prostate cancer is very survivable," says Dr. Terry Mason, a volunteer member of the American Cancer Society Prostate Cancer Advisory Group. "It's a very treatable disease."

But depending on the type of treatment selected, a prostate cancer patient can suffer some rather uncomfortable side effects, including impotence and incontinence.

According to the National Cancer Institute (NCI), surgery to remove a tumor can result in impotence if the nerves that control erection are damaged during the procedure. The patient may also suffer short-term incontinence while recuperating.

Radiation treatment can cause bladder and bowel incontinence, too. It can also lead to impotence, although that effect does not take place immediately.

"Men may start out being sexually active, and then as the radiation scarring and damage develops over the next two to three years, there's a gradual decrease in the levels of potency," says Dr. Brooks. "With surgery, it's the opposite. There is some initial difficulty, and then things improve over time."

Each type of treatment has positive and negative aspects. For example, surgical patients can opt for a "nerve-sparing" procedure which is less likely to interfere with sexual function.

According to the American Cancer Society, patients receiving radiation can choose between external beam treatment or an internal approach called brachytherapy in which radioactive "seeds" are implanted in the tumor.

Watchful Waiting Viable Option for Some

"There is no proven best treatment," notes Dr. Brooks. "They need to investigate all the treatment options, and understand all the up sides and potential complications from each option."

A patient also might decide that it is just not worth getting treated, particularly if the tumor is slow-growing. In a tactic called "watchful waiting," the patient does not receive treatment. Instead, regular checkups monitor the progress of the cancer.

Some doctor's believe if a man's life expectancy is low due to old age or other health problems, surgery or radiation for prostate cancer might actually do more harm than good.

"I have that conversation a lot with the older gentlemen, particularly those guys over 75 years old," Dr. Mason says. "Those are the guys who really have to weigh whether it's worth it."

New vaccine therapies to attack prostate cancer could be on the horizon, says Dr. Brooks. There are two or three vaccines under development that would prompt a patient's immune system to target cancer cells.

One vaccine undergoing phase 1 trials appeared to promote immune responses in 70 percent of the enrolled patients, notes a recent study.

Dr. Mason adds, however, that those drugs are still many years away.

In the meanwhile, there are steps men can take to decrease their risk of getting prostate cancer.

For example, some studies have shown that chemicals released from cooking muscle proteins at high temperatures could increase the risk of prostate cancer in some men.

Other studies have shown that a diet rich in animal fat or meat could be linked to a higher incidence of prostate cancer, according to the NCI.

"Before I would put my money in a vaccine, I would want to think about some of the dietary things people can do," adds Dr. Mason.

Always consult your physician for more information.

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March 2009

Coping with Prostate Cancer

Watch and wait, or expectant therapy, is characterized by careful monitoring of the prostate cancer.

This may be recommended by your physician if the prostate cancer is in a very early stage, especially in the cases of older men with small tumors that are expected to grow very slowly, are confined to one area of the prostate, or are not causing any symptoms or other medical problems.

Because prostate cancer cells often spread very slowly, many older men who have the disease may not need more extensive treatment.

Every person is different, and not all men have the same experience, thoughts, or feelings. The prostate gland is critical to a man's sexual function; the possibility and actual diagnosis of prostate cancer can instill fear and anxiety for patients since it threatens their masculinity.

They fear they will never be a "real man" again in terms of sexual performance. Rather than adopting a course of action in response to these fears, consider educating yourself so that you can make the best health decisions possible.

Treatment considerations vary, as do their effects on sexual function. It is normal to be scared, angry, or depressed when given this diagnosis. The good news is that prostate cancer is very treatable.

Each patient, together with their partner or family, should try their best to communicate about the diagnosis of prostate cancer, how it makes them feel, what their expectations are, what their fears are, etc.

Prostate cancer affects not only the patient, but also those closest to them. Arm yourself and those around you with information and take the time to learn about your cancer diagnosis, the risks and benefits of various therapies, and the impact they may have on your life.

Take the time for you and those you love to become informed. Sometimes, men are embarrassed or feel guilty for ignoring possible signs of prostate cancer, or avoiding visits with their physician due to the nature of a prostate examination.

Other times, men avoid going back to see their physician once the diagnosis of prostate cancer is made, choosing instead to treat themselves with alternative medicines, or simply to deny the diagnosis of cancer altogether.

It is your responsibility to be honest with yourself and your healthcare provider, in order to form a partnership with your physician that is based on candid, honest dialogue, to ensure the best care possible. It is normal to consider a second opinion and investigate all of the care options available to you, until you have made the best choice for yourself.

Be assured that physicians understand getting a second opinion to confirm the diagnosis, or to provide a different perspective on treatment options. Above all, become an advocate for your personal healthcare.